Lyme disease

Lyme disease is a bacterial infection that is spread through the bite of one of several types of ticks.

Alternative Names

Borreliosis; Bannwarth syndrome

Causes

Lyme disease is caused by bacteria called Borrelia burgdorferi (B. burgdorferi). Blacklegged ticks and other species of ticks can carry these bacteria. The ticks pick up the bacteria when they bite mice or deer that are infected with B. burgdorferi. You can get the disease if you are bitten by an infected tick.

Lyme disease was first reported in the United States in 1977 in the town of Old Lyme, Connecticut. The same disease occurs in many parts of Europe and Asia. In the United States, most Lyme disease infections occur in the following areas:

Northeastern states, from Virginia to Maine

North-central states, mostly in Wisconsin and Minnesota

West Coast, mainly in the northwest

There are 3 stages of Lyme disease.

Stage 1 is called early localized Lyme disease. The infection has not yet spread throughout the body.

Stage 2 is called early disseminated Lyme disease. The bacteria have begun to spread throughout the body.

Stage 3 is called late disseminated Lyme disease. The bacteria have spread throughout the body.

Risk factors for Lyme disease include:

Doing outside activities that increase tick exposure (for example, gardening, hunting, or hiking) in an area where Lyme disease is known to occur

Having a pet that may carry ticks home

Walking in high grasses

Important facts about tick bites and Lyme disease:

In most cases in the U.S., a tick must be attached to your body for 24 - 36 hours to spread the bacteria to your blood. Ticks that cause Lyme disease in Europe transmit the bacteria more quickly, within 24 hours.

Blacklegged ticks can be so small that they are almost impossible to see. Many people with Lyme disease never even see or feel a tick on their body.

Most people who are bitten by a tick do not get Lyme disease.

Symptoms

Symptoms of early localized Lyme disease (stage 1) begin days or weeks after infection. They are similar to the flu and may include:

There may be a "bull's eye" rash, a flat or slightly raised red spot at the site of the tick bite. Often there is a clear area in the center. It can be large and expanding in size. This rash is called erythema migrans. Without treatment, it can last 4 weeks or longer.

Symptoms may come and go. Untreated, Lyme disease can spread to the brain, heart, and joints.

Symptoms of early disseminated Lyme disease (stage 2) may occur weeks to months after the tick bite, and may include:

Numbness or pain in the nerve area

Paralysis or weakness in the muscles of the face

Heart problems, such as skipped heartbeats (palpitations), chest pain, or shortness of breath

Symptoms of late disseminated Lyme disease (stage 3) can occur months or years after the infection. The most common symptoms are muscle and joint pain. Other symptoms may include:

Abnormal muscle movement

Joint swelling

Muscle weakness

Numbness and tingling

Speech problems

Thinking (cognitive) problems

Exams and Tests

A blood test can be done to check for antibodies
to the bacteria that cause Lyme disease. The most commonly used is the ELISA for Lyme disease
test. An immunoblot test is done to confirm ELISA results. Be aware, though, in the early stage of infection, blood tests may be normal.

In areas where Lyme disease is more common, your health care provider may be able to diagnose early disseminated Lyme disease (Stage 2) without doing any lab tests.

Treatment

Persons bitten by a tick should be watched closely for at least 30 days to see if a rash or symptoms develop.

A single dose of the antibiotic doxycycline may be given to someone soon after being bitten by a tick, when all of these conditions are true:

The person has a tick that can carry Lyme disease attached to his or her body. This usually means that a nurse or doctor has looked at and identified the tick.

The tick is thought to have been attached to the person for at least 36 hours.

The person is able to start taking the antibiotic within 72 hours of removing the tick.

The person is 8 years or older and is not pregnant or breastfeeding.

Local rate of ticks carrying B. burgdorferi is 20 percent or higher.

A 10 day to 4-week course of antibiotics is used to treat people who are diagnosed with Lyme disease, depending on the choice of drug:

The choice of antibiotic depends on the stage of the disease and the symptoms.

Common choices include doxycycline, amoxicillin, azithromycin, cefuroxime, and ceftriaxone.

Pain medicines, such as ibuprofen, are sometimes prescribed for joint stiffness
.

Outlook (Prognosis)

If diagnosed in the early stages, Lyme disease can be cured with antibiotics. Without treatment, complications involving the joints, heart, and nervous system can occur. But these symptoms are still treatable and curable.

In rare cases, a person keeps having symptoms that interfere with daily life after they have been treated with antibiotics. This is also known as post-Lyme disease syndrome. The cause of this syndrome is unknown.

Symptoms that occur after antibiotics are stopped may not be signs of active infection and may not respond to antibiotic treatment.

Possible Complications

Stage 3, or late disseminated, Lyme disease can cause long-term joint inflammation (Lyme arthritis) and heart rhythm problems. Brain and nervous system problems are also possible, and may include:

Decreased concentration

Memory disorders

Nerve damage

Numbness

Pain

Paralysis of the face muscles

Sleep disorders

Vision problems

When to Contact a Medical Professional

Call your health care provider if you have:

A large, red, expanding rash that may look like a bull's eye.

Had a tick bite and develop weakness, numbness, tingling, or heart problems.

Symptoms of Lyme disease, especially if you may have been exposed to ticks.

Prevention

Take precautions to avoid tick bites. Be extra careful during warmer months. When possible, avoid walking or hiking in the woods and areas with high grass.

If you do walk or hike in these areas, take measures to prevent tick bites:

Wear light-colored clothing so that if ticks land on you, they can be spotted and removed.

Wear long sleeves and long pants with pant legs tucked into your socks.

Spray exposed skin and your clothing with insect repellant
, such as DEET or permethrin.

After returning home, remove your clothes and thoroughly inspect all skin surface areas, including your scalp. Shower as soon as possible to wash off any unseen ticks.

For help in finding a doctor or health service that suits your needs, call the UPMC Referral Service at 412-647-UPMC (8762) or 1-800-533-UPMC (8762). Select option 1.

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